AB1805-HPR SERVICE EVALUATION OF COMBINED RHEUMATOLOGY/ OBSTETRIC CLINIC, SOUTH TEES NHS FOUNDATION TRUST, UNITED KINGDOM’‘
Authors: F. A. Khan, G. Janakiraman, M. Shivanath, R. Gul, S. Chin, E. Steele, D. Kong
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> Multidisciplinary management in a combined clinic improves patient experience and outcomes for pregnant women with inflammatory rheumatic diseases (IRD). Achieving better IRD control pre, during, and post-pregnancy with pregnancy-compatible disease-modifying anti-rheumatic therapies (DMARDs) reduces maternal and foetal mortality/ morbidity minimising complications. EULAR published recommendations for core data sets around maternal, pregnancy, and treatment information for pregnancy registries in Inflammatory rheumatic diseases. <h3>Objectives</h3> Service evaluation of the Combined Rheumatology Obstetrics clinic held in our hospital to evaluate pregnant patients with Inflammatory rheumatoid diseases against the EULAR recommendations. To improve Patient and disease outcome in terms of maternal health and fetal health. <h3>Methods</h3> Retrospective data was collected on interventions and outcomes of pregnancies in 40 women with Inflammatory rheumatic diseases seen in theCombined Rheumatology/ Obstetric Clinic from November 2020 to February 2022 reviewing clinic letters and medical notes. <h3>Results</h3> 77% of patients had inflammatory arthritis including rheumatoid, psoriatic, juvenile idiopathic, and axial spondylo-arthritis.15% had connective tissue disease (CTD) including lupus with anti-phospholipid syndrome, Bechet's and undifferentiated CTD. 2%patients did not have a formal IRD diagnosis. 12.5% of patients had only pre-pregnancy counselling, 2.5% had miscarriages. Of the remaining 85% of pregnant patients' 10% had obstetric care/ delivery in other trusts. Treatment received by patients 12 months prior to conception included DMARDs (37%), biologics (24%), combination (8%), and steroids (10%). 25% were on no treatment.During pregnancy 29% received oral DMARDs, 11% biologics and 16% needed steroids. 50% of patients did not require any treatment. Interventions done in the clinic included medication review (100%), VTE assessments (100%), commenced VTE prophylaxis (7.5%), change in DMARD dosage (10%), additional medication added (10%), intramuscular/ intra-articular steroid injections (16%) and physiotherapy referrals (10%). Maternal adverse outcomes include 5% preeclampsia, 0.07% gestational diabetes and 0.02% pregnancy-induced hypertension and foetal growth restriction. 93.3% were full-term deliveries. Only 10% had adverse neonatal outcomes including 6.6% preterm births. None had congenital heart block. 3.3% had congenital malformations unrelated to IRD/ DMARD therapy.Patient satisfaction surveys were sent out to 40 patients with a 30% response rate. The patient satisfaction questionnaire revealed all patients had their consultation with rheumatology and obstetric consultants with 100%satisfaction. 100% felt the staff was supportive and they would recommend our service to friends and family. Of 66.7% of patients receiving pre-pregnancy counselling, 50% were in the combined clinic. Of the 33.3% of patients not receiving counselling 22.2% felt they would have benefitted from it. <h3>Conclusion</h3> Our service evaluation of the combined rheumatology/ obstetric clinic revealed favourable outcomes for the mother and baby with high patient satisfaction rates. The clinic offered appropriate timely interventions to control IRD improving pregnancy outcomes. The future aim is to deliver this high-quality service to all pregnant patients with IRD through robust referral pathways to improve the patient experience. <h3>Reference</h3> [1] EULAR published recommendations for core data sets around maternal, pregnancy, and treatment information for pregnancy registries in Inflammatory rheumatic diseases. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.